Healthcare Provider Details

I. General information

NPI: 1497355390
Provider Name (Legal Business Name): DELIA M. REYES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/28/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 2ND ST.
CORDOVA AK
99574
US

IV. Provider business mailing address

705 2ND ST.
CORDOVA AK
99574-2290
US

V. Phone/Fax

Practice location:
  • Phone: 210-535-2869
  • Fax:
Mailing address:
  • Phone: 907-424-3622
  • Fax: 907-424-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number165874
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27947
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: